Beating A Killer
Cancer was once the end of the line. Today, it can be managed and defeated
There are other problems associated with radiation. A recent study of nearly 1,400 kids diagnosed with Hodgkin's disease between 1955 and 1986 shows they have 18 times the risk of developing another cancer--most commonly breast or thyroid tumors--as do healthy people. Again, radiation was the culprit.
Research on young survivors has also shed some light on the unanticipated hazards of chemotherapy. Testicular cancer, for example, which usually strikes men in their 20s, is 95 percent curable. But the chemo regimen used, which includes an ingredient called cisplatin, has some bad effects on the kidneys and, perhaps, the heart.
While most of the insights into long-term survivorship come from children, adults offer another useful perspective on these late effects. In 1971, Ellen Stovall was 24 years old and had just given birth four weeks before when she was diagnosed with Hodgkin's disease. This cancer starts in the lymph system and attacks the body's immune and blood production systems. At its worst, the cancer spreads and can destroy the lungs and the liver. Stovall was told that she could hope, at best, to see her daughter's second birthday.
With massive radiation treatment, Stovall survived. What she was not told, however, was that the treatment that saved her life would also throw her into immediate menopause. There was no discussion of banking her eggs--it simply wasn't an option at the time. Indeed, no one thought that she would live long enough to suffer any long-term consequences that come with 30 years of menopause. She developed both cardiac arrhythmia from radiation and premature aging of her organs. And on top of that, she watched her friends have their second and third babies, and became more and more disconsolate. She found herself feeling forgetful, disorganized, generally less competent.
Stovall isn't alone. It's not just the trauma of cancer but also the long-term effects of the chemotherapy and radiation. Once it was believed that the brain was protected from the toxins of chemotherapy by the "blood-brain barrier," a layer of cells that, theoretically, prevents large molecules in the bloodstream from invading the brain. But this protective barrier isn't foolproof; it can be broken down by, among other things, radiation and inflammation that many of the chemotherapies cause. The result is called "chemo-brain," characterized by maddening memory loss and compromised "executive function"--that is, as Stovall recognized, the ability to organize and juggle tasks.
Puzzles. None of the results of the chemo-brain studies are crystal clear. No one really knows, for example, why the cognitive problems show up. Is the impairment the result of the chemotherapy or of the stress and anxiety associated with simply having a cancer diagnosis? Or are some people simply predisposed genetically to suffer cognitive decline? A recent study suggests that one possible risk factor for chemotherapy-induced cognitive decline is the presence of a gene called APOE, which is also associated with increased risk for Alzheimer's disease.
Clearly, it's not just the brain's cognitive functions that are affected. As with Joe Fred Starr, depression for cancer patients and survivors is another serious problem. In the past, depression in cancer patients was underdiagnosed and undertreated. "There was a popular misconception that everyone who gets cancer gets depressed," says William Breitbart, the chief of psychiatry at Sloan-Kettering. But in fact, he points out, the kind of depression experienced by Starr is shared by just 15 to 25 percent of other cancer patients. Some cancer patients do become sad, some become anxious, while others go through what can only be called a grief reaction. But a large majority of cancer patients don't suffer clinical depression at all. And when they do, it can be successfully treated. "I can honestly say now that I am happier than a lot of my friends are," Starr says. "And they don't have anything wrong with them." He exercises; he travels; he lives a full life with his wife. And while he acknowledges that some days are better than others, "it was just time to stop feeling sorry for myself and realize I didn't want to take that old man's advice and drive into a lake."